Look What Happens When You Pay Attention To Neglected Tropical Diseases

Bill Gates, right, and his wife Melinda are co-chairs of the Bill and Melinda Gates Foundation. The Foundation's contributions have been critical in the progress on neglected tropical disease (NTD) control. (AP Photo/Kamil Zihnioglu, Pool)

Imagine that. Paying attention to a problem and working together to solve it actually works. Five years after the London Declaration on Neglected Tropical Diseases (NTD) convened to set ambitious goals for NTD control for the year 2020, the World Health Organization (WHO) recently announced "unprecedented progress against" 10 NTDs. You may not have heard of NTDs because they've after all been neglected...by the media and many governments, funding agencies, businesses, etc. In other words, if major infectious diseases around the world were to have a party (which would be a horrible party to attend), NTDs would be the wallflowers in the corner, overlooked by many policymakers, scientists and funders. But rather than nice John Hughes movie wallflowers, these Carrie-like wallflowers (which include a rogues gallery of worms, parasites and other nasties) have continued to cause much suffering around the world. However, the WHO announcement at the midpoint of the 10-year goals from the London Declaration is the result of important turning points that have occurred over the past two decades.

1 billion people treated for at least one neglected tropical disease in 2015 alone.

556 million people received preventive treatment for lymphatic filariasis (elephantiasis).

More than 114 million people received treatment for onchocerciasis (river blindness): 62% of those requiring it.

Only 25 human cases of Guinea-worm disease were reported in 2016, putting eradication within reach.

Cases of human African trypanosomiasis (sleeping sickness) have been reduced from 37,000 new cases in 1999 to well under 3,000 cases in 2015.

Trachoma–the world’s leading infectious cause of blindness–has been eliminated as a public health problem in Mexico, Morocco and Oman.

More than 185,000 trachoma patients had surgery for trichiasis worldwide and more than 56 million people received antibiotics in 2015 alone.

Visceral leishmaniasis: in 2015 the target for elimination was achieved in 82% of sub-districts in India, 97% of sub-districts in Bangladesh and in 100% of districts in Nepal.

Only 12 reported human deaths were attributable to rabies in the WHO Region of the Americas in 2015, bringing the region close to its target of eliminating rabies in humans by 2015.

One turning point was the London Declaration. A second has been the resources, efforts and energy provided by the Bill and Melinda Gates Foundation. In his interview with Bloomberg's Manus Cranny, Bill Gates, co-chair of the Bill and Melinda Gates Foundation, said its been "five years of great progress," but there is also more work to be done:

A third has been the coming together of some higher-income-country governments, pharmaceutical companies and organizations to tackle NTDs together. But, of course, a major threat to this progress has been President Donald Trump's proposed massive cuts to health and research programs. With some NTDs, such as Chagas disease, making their way into the United States, these funding cuts will end up hurting the U.S. population and businesses in many hidden ways (similar to how NTDs affect the entire world in an insidious, vampire-like manner). Ironically, those states at greatest risk for NTDs such as Chagas disease went Trump's way during last year's election, such as Texas and Florida. Gates described Trump's cuts, such as to the United Nations Population Fund, as "disappointing and unfortunate."

Dr. Peter Hotez, dean of the National School of Tropical Medicine and editor-in-chief of PLoS Neglected Tropical Diseases (NTDs), has been a global leader in bringing attention to and fighting NTDs (AP Photo/John Mone)

Dr. Hotez, who is also editor-in-chief of PLoS NTDs and has been leading the global charge against NTDs, described the 10-year journey of the journal:

In 2005 together with David Molyneux, Alan Fenwick, Eric Ottesen and others we proposed the concept of integrating NTD control through what we then called a "rapid impact package" of essential medicines. In 2012 the London Declaration for NTDS accelerated drug company donations. More than a decade after these activities the Global Burden of Disease Study has shown great progress in prevalence reductions of some of the NTDS, especially LF, trachoma and onchocerciasis to the point where they may one day be eliminated. For others progress has been more modest. Complicating these gains has been the rise of vector borne and zoonotic NTDS such as leishmaniasis, Chagas disease, arbovirus and trematode infections, and Ebola. We're still trying to undrstand the role of shifting poverty (blue marble health), climate change, and conflict in promoting these diseases and we're also going to need better control tools or even vaccines. Since these efforts began PLOS NTDS has been there as an open access journal to give a voice to the scientists and neglected populations‎ in the disease endemic countries. Today a quarter of PLOS NTDS authors are from Africa, and similar numbers from Asia and the Americas!

But the war on NTDs is far, far from done and NTDs still remain very neglected. And even within NTDs, some NTDs have been more neglected than others or in different ways. Imagine being a wallflower among the wallflowers. For example, Maria Elena Bottazzi, Ph.D., FASTMH, associate dean, National School of Tropical Medicine and professor of pediatrics at the Baylor College of Medicine and Texas Children’s Hospital, said, “For the first time, the NTD Summit covered the urgent need for an increase access to Chagas disease treatment and the advances in research and development leading to new drugs, vaccines and diagnostics.”

Again "neglected" does not mean "not important." With climate change (yes, yes, yes, this is real...and the world is not flat and you get wet when you jump into a swimming pool) and pollution, the range of some NTDs is expanding and may be creeping into parts of higher income countries. NTDs are closer to you than you think. For example, only about a century ago, hookworm was a real problem throughout the U.S. South. And when large parts of the world are being sapped by NTDs, potential markets and the world's economy as whole cannot grow and benefit everyone. Yes, we are all connected in a complex system. Now if everyone can realize the benefits of working together.

I’ve been in the worlds of business, medicine, and global and public health. And these worlds are a lot more similar and different than you think. Currently, I am an Associate Professor of International Health at the Johns Hopkins Bloomberg School of Public Health, Executiv...